Factors affecting the results of analgesic therapy. Results of the Russian multicentre study of NOTE (NSAID: Open-label Trial of Efficacy).

AIM: To identify factors affecting the effectiveness of NSAIDs in patients with OA and LBP. MATERIALS AND METHODS: An observational study was conducted to evaluate the effectiveness of a 2-week course of NSAIDs in OA and LBP in real clinical practice. The study group consisted of 3604 patients with OA and LBP (60.6% women and 39.4% men, mean age 55.0±13.4 years). According to the study design, aceclofenac (Airtal) and other NSAIDs used in the ratio 1:1. The main criterion of effectiveness was the frequency of complete pain relief after 2 weeks of therapy. In addition, the decrease of pain and general health were determined on a 10-point numerical rating scale (NRS). We compared the frequency of complete pain relief in patients who had and did not have the studied factors. The value of the studied factors was determined using OR (95% CI). RESULTS: Most patients received aceclofenac (54.9%), as well as diclofenac (2.0%), ketoprofen (1.9%), lornoxicam (2.2%), meloxicam (13.7%), naproxen (2.1%), nimesulide (5.8%), celecoxib (5.9%), ethicoxib (7.1%) and other NSAIDs (4.4%); 56.2% of patients received muscle relaxants, mainly tolperisone (74.7%), vitamin B (10.4%), and proton pump inhibitors (42.8%). Complete pain relief was achieved in 54.8% of patients. The pain decrease and general health improvement were (for NRS) 63.9±13.4% and 61.7±14.8%, respectively. The efficacy of aceclofenac was slightly higher than in the whole group: complete pain relief was in 59.9% of patients. Adverse events in aceclofenac use were observed in 2.3% of patients, other NSAIDs-from 2.4 to 14.1%. The frequency of complete pain relief was higher in men: OR 1,239 (95% CI 1.08-1.418; p=0.002), who had the first episode of pain - OR 3.341 (95% CI 2.873-3.875; p=0.000), a good" response " to NSAIDs in history - OR 1.656 (95% CI 1.385-1.980; p=0.000) and received NSAIDs in combination with muscle relaxants - OR 1.218 (95% CI 1.067-1.390; p=0.004). The effect of therapy is lower in patients 65 years and older-OR 0,378 (95% CI 0.324-0.442; p=0,000), with body mass index >30 kg/m² - OR 0.619 (95% CI 0.529-0.723; p=0.000), with severe pain (≥7 points NRS) - OR 0.662 (95% CI 0.580-0.756; p=0.002), with pain at rest, - OR 0.515 (95% CI 0.450-0,589; p=0.000), pain at night - OR 0.581 (95% CI 0.501-0.672; p=0.000) and the presence of stiffness - OR 0.501 (95% CI 0.438-0,573; p=0.000). Treatment results are significantly worse in the cases of combination of LBP and joint pain, as well as pain in the trochanter major and pes anserinus area (p<0.001). CONCLUSION: NSAIDs are the first-line medications for the pain treatment in LBP and OA. Aceclofenac is effective and safe in this conditions. When carrying out analgesic therapy should take into account factors that affect the effectiveness of treatment: old age, overweight, insufficient effect of NSAIDs in history, severe pain, signs of "inflammatory" pain, multiple sources of pain.

[Hepatic haemangioma as sistemic manifestation of rheumatoid arthritis].

This article presents the clinical data regarding to the incidence of hepatic haemangioma in rheumatoid arthritis (RA) patients. Haemangioma of the liver has been diagnosed by ultrasonography dramatically oftener in RA than in OA: in 8 from 37 RA pts and neither in 120 osteoarthritis pts. Hepatic haemangioma was associated with long standing erosive RA, extra-articular RA manifestations, high levels of rheumatoid factor and ACCP. Moreover in RA pts with hepatic haemangioma we revealed significantly raised levels of pro-inflammatory cytokines, which can impact on the angiogenesis in RA. Obtained clinical data may contribute in the understanding of liver vessels involvement in RA and pose the role of systemic connective tissue lesion and immune inflammation in this process.

Efficiency and safety of long-term artrofoon treatment in rheumatoid arthritis.

In patients with rheumatoid arthritis, prolongation of artrofoon therapy to 2 years led to maintenance of the positive clinical effect attained after 6-month treatment. Moreover, significant improvement was observed by some parameters (integral pain intensity, swelling index, Ritchie articular index, morning stiffness, and articular score). No side effects related to artrofoon treatment were observed throughout the treatment period in the main group. The results indicate high efficiency and good tolerability of the preparation and attest to advisability of its long-term use.

Effect of combination of anticytokine preparations anaferon and artrofoon on immune inflammation in rheumatoid arthritis.

Treatment with a combination of artrofoon and anaferon significantly reduced clinical and laboratory parameters of rheumatoid inflammation and significantly decreased the content of antiinflammatory cytokines in the blood. These findings attest to antiinflammatory and immunomodulating effects of these preparations.

Efficiency of potentiated antibodies to tumor necrosis factor-alpha (Artrofoon) in the therapy of patients with rheumatoid arthritis.

Antiinflammatory activity of a new preparation Artrofoon (antibodies against tumor necrosis factor-alpha in ultralow doses) and nonsteroid antiinflammatory drug diclofenac in patients with rheumatoid arthritis was compared in an open randomized trial. The course of treatment with Artrofoon more significantly improved clinical and laboratory signs in patients with the articular form of rheumatoid arthritis than diclofenac.

[New trends in the study of the primary fibromyalgic syndrome]. / Novye napravleniia v izuchenii sindroma pervichnoi fibromialgii.

The study of 1240 patients making complaints of osteomuscular pains showed that 9.6% had clinical signs of primary fibromyalgia (PF). It provided new data on the clinical signs of PF, clinical and biochemical changes in this syndrome. The diagnostic and informative values of some signs and symptoms of PF are compared and new approaches to optimizing diagnostic criteria are outlined in the paper. The paper also gives new data on the combined therapy for PF, including the use of dimexide with nonhormonal antiinflammatory agents and sessions of acupuncture that promotes the normalization of dysfunctions. This may be useful for PF patients due to easy-to-use, available, and inexpensive treatment.

[Isolation of non-type-specific protein antigens of Streptococcus group B]. / Poluchenie netipospetsificheskikh belkovykh antigenov streptokokka gruppy B.

Hydrochloride extracts obtained from group B streptococcal strains of different serotypes have proved to be the source of type-nonspecific protein antigens, precipitated with ethanol and studied by gel chromatography and spectrophotometric scanning in ultraviolet rays. Thus, 2 or 3 antigens, one of them found to be common for streptococci of groups A, B and G, as well as the admixture of group-specific polysaccharide, have been detected. In extracts obtained from group B streptococcal strains of different serotypes a common protein antigen, specific only for group B, has been detected. The suitability of gel chromatography with the use Toyopearl gel HW-55F for the preparative isolation of the specific fraction of protein type-nonspecific antigen with a view to the subsequent study of immune response to group B streptococci has been shown.

[Immune reactions with streptococcal antigens and homologous myocardial tropomyosin in rheumatoid arthritis with visceritis]. / Immunnye reaktsii s antigenami streptokokkov i gomologichnym tropomiozinom miokarda pri revmatoidnom artrite s vistseritami.

A humoral and cellular immune response to polysaccharide and protein antigens of the cell wall of streptococci (Groups A, B, C and G) and to homologous myocardial tropomyosin was studied in patients with rheumatoid arthritis (RA) with different clinical variants of disease and in healthy persons. In RA patients humoral and cellular immune reactions to polysaccharide and protein streptococcal antigens were especially marked with the use of the structural components of the cell wall of streptococcus, Group B. Elevated titers of antibodies to homologous myocardial tropomyosin were detected in RA patients as compared to those in a group of healthy persons, an average titer of antibodies to tropomyosin in RA patients with systemic symptoms being much higher than in patients with an articular form of disease. The authors emphasized a possible role of antigens of the cell wall of streptococcus, Group B, in the occurrence and development of immunopathological reactions in RA, and a role of antibodies to myocardial tropomyosin in immunopathogenesis of cardiac disorder in this disease.